E&M for Life Flight for Physician

AmyCPCCPCH

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Hello Everyone. I am trying to figure out what code a physician would use to bill for his services he provided on a life flight from one hospital to another. This is just for the professional services the physician performed, life flight already billed with the appropriate A code.

I think critical care services would work but the physician only provided care for 21 minutes and to use a critical care code he would have had to provide atleast 30 minutes of critical care. One person told me to use 99499 since it was under 30 minutes but I don't know if that is correct. What do you guys think?
 

pawleygirl

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Flight Physician

CPC directs us to us Critical Care codes for physician transport. At that point I believe we have to follow Critical Care guidelines and charge an E&M. However, did the physician read or assist in the patient's care before the flight, this is additional Critical Care time. There should be pre and post report delivery. Was the physician in charge of the situation and providing additional direction? Consider 99288. I'd like to see what others think.
 
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99291 or 99499

It is not 99288 as that is for situations where the physician stays in the hospital and is directing the care of the patient via phone/radio contact with the EMT personnel .

If additional time was spent prior to flight, add that time to your total critical care time. If you still do not have 30 minutes, then 99499 is the way to go. I would base my fee on 99291 (but prorate for the lessor time ... for example - 21 minutes is 70% of 30 minutes, so I'd charge 70% of the 99291 fee)

Hope that helps

F Tessa Bartels, CPC, CEMC
 

AmyCPCCPCH

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Thanks everyone for your help. We did look at the 99288 but saw that it was for when the physician was in the hospital communicating with ambulance or rescue outside of the hospital.

According to the provider all the time spent equals 21 minutes. Paying the percentage of 99291 is a great idea, they are actually billing more then the 99291 would pay.

Thanks again,
Amy
 

pawleygirl

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Flight Physician

Please direct me to anywhere where it is documented that we can pro-rate a fee. My physicians have a few ideas...
 
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Unlisted E/M 99499

99499 is UNLISTED E/M which has no set fee in your fee schedule, so you must decide on a fee each time you use this or any unlisted procedure code.

To do this, you typically try to base that fee on some similar procedure that IS on your fee schedule.

That's why I suggested prorating your fee. I don't think it would be appropriate to charge the entire fee since you didn't provide the entire service (if you had, you'd be coding 99291).

In any case, what you charge and what gets paid are two different things.

F Tessa Bartels, CPC, CEMC
 
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